Primer Hiperparatiroidide Preoperatif Görüntüleme ve Cerrahi Başarı: 19 Olguluk Retrospektif Analiz Primer Hiperparatiroidide Lokalizasyon ve Cerrahi

Year 2026, Volume: 9 Issue: 1, 7 - 13, 16.03.2026

Yusuf Emre Altundal , Süleyman Büyükaşık

https://izlik.org/JA43JP63UA

Abstract

Amaç: Bu çalışmada primer hiperparatiroidi tanısıyla opere edilen hastaların klinik, görüntüleme ve cerrahi sonuçlarının retrospektif olarak değerlendirilmesi ve preoperatif ultrasonografi (USG) ile Tc-99m sestamibi (MIBI) sintigrafisinin lokalizasyon başarısının analiz edilmesi amaçlanmıştır. Gereç ve Yöntem: 2019–2025 yılları arasında İstanbul Aydın Üniversitesi Tıp Fakültesi Genel Cerrahi Kliniği’nde primer hiperparatiroidi nedeniyle opere edilen 19 hasta retrospektif olarak incelendi. Sekonder ve tersiyer hiperparatiroidi ile MEN sendromu öyküsü olan hastalar çalışma dışı bırakıldı. Demografik veriler, biyokimyasal parametreler, görüntüleme bulguları, uygulanan cerrahi yöntem ve erken dönem sonuçlar analiz edildi. Bulgular: Hastaların yaş ortalaması 50,4±16,5 yıl olup %73,7’si kadındı. Tüm hastalara USG, 15 hastaya (%78,9) MIBI sintigrafi uygulandı. En az bir görüntüleme yöntemi ile lokalizasyon başarısı %94,7 olarak saptandı. USG ile lokalizasyon oranı %84,2, MIBI ile %93,3 olup yöntemler arasında anlamlı fark izlenmedi (p>0,05). Hastaların %84,2’sine minimal invaziv paratiroidektomi uygulandı. Preoperatif total kalsiyum ve PTH düzeyleri postoperatif 24. saatte anlamlı derecede düştü (p<0,001) ve tüm hastalarda erken dönemde normokalsemi sağlandı. Sonuç: Primer hiperparatiroidide retrospektif verilerimiz, USG ve Tc-99m sestamibi sintigrafisinin yüksek lokalizasyon başarısı sağladığını ve uygun hastalarda minimal invaziv paratiroidektominin güvenle uygulanabildiğini göstermektedir.

Keywords

Primer Hiperparatiroidi , Paratiroid Adenomu , Ultrasonografi , Tc-99m Sestamibi , Minimal İnvaziv Paratiroidektomi

Supporting Institution

T.C. İSTANBUL AYDIN ÜNİVERSİTESİ GİRİŞİMSEL OLMAYAN KLİNİK ARAŞTIRMALAR ETİK KURULU KARARI

Project Number

32/2026

Preoperative Imaging and Surgical Outcomes in Primary Hyperparathyroidism: A Retrospective Analysis of 19 Cases

https://izlik.org/JA43JP63UA

Abstract

Objective: This study aimed to retrospectively evaluate the clinical, imaging, and surgical outcomes of patients operated on for primary hyperparathyroidism and to analyze the localization success of preoperative ultrasonography (USG) and Tc-99m sestamibi (MIBI) scintigraphy. Materials and Methods: Nineteen patients who underwent surgery for primary hyperparathyroidism at the Department of General Surgery, Istanbul Aydın University Faculty of Medicine between 2019 and 2025 were retrospectively reviewed. Patients with secondary or tertiary hyperparathyroidism and those with a history of multiple endocrine neoplasia (MEN) syndrome were excluded. Demographic characteristics, biochemical parameters, imaging findings, surgical approach, and early postoperative outcomes were analyzed. Results: The mean age of the patients was 50.4±16.5 years, and 73.7% were female. All patients underwent USG, and 15 patients (78.9%) underwent MIBI scintigraphy. Localization was achieved in 94.7% of patients with at least one imaging modality. The localization rate was 84.2% with USG and 93.3% with MIBI, with no statistically significant difference between the two modalities (p>0.05). Minimally invasive parathyroidectomy was performed in 84.2% of patients. Preoperative total calcium and PTH levels significantly decreased at postoperative 24 hours (p<0.001), and early normocalcemia was achieved in all patients. Conclusion: Our retrospective data indicate that USG and Tc-99m sestamibi scintigraphy provide high localization success in primary hyperparathyroidism and enable the safe application of minimally invasive parathyroidectomy in appropriately selected patients.

Keywords

Primary Hyperparathyroidism , Parathyroid Adenoma , Ultrasonography , Tc-99m Sestamibi , Minimally Invasive Parathyroidectomy

Project Number

32/2026

References

• Mutlu, F., & Aka, B. U. (2023). Minimal invaziv paratiroidektomi. Tek merkez deneyimi. Acta Medica Nicomedia, 6(3), 434-440.
• Fu, C. H., & Chen, H. F. (2022). Parathyroid adenoma presenting as chronic pancreatitis: A case report and literature review. Medicine, 101(46), e31750.
• Wilhelm, S. M., Wang, T. S., Ruan, D. T., Lee, J. A., Asa, S. L., Duh, Q. Y., ... & Carty, S. E. (2016). The American Association of Endocrine Surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA surgery, 151(10), 959-968.
• Aygün, N., İşgör, A., & Uludağ, M. (2019). Primer hiperparatiroidili hastalarda preoperatif ultrasonografi ve sintigrafinin ilk görüntülemede patolojik bezin lokalizasyonunda etkinliği. Medical Bulletin of Sisli Etfal Hospital, 53(4), 379–384. https://doi. org/10.14744/SEMB.2019.37097
• Noureldine, S. I., Gooi, Z., & Tufano, R. P. (2015). Minimally invasive parathyroid surgery. Gland surgery, 4(5), 410.
• Aygün, N., & Uludağ, M. (2019). Intraoperative adjunct methods for localization in primary hyperparathyroidism. Şişli Etfal Hastanesi Tip Bülteni, 53(2), 84-95.
• Solorzano, C. C., & Carneiro-Pla, D. (2014). Minimizing cost and maximizing success in the preoperative localization strategy for primary hyperparathyroidism. Surgical Clinics, 94(3), 587-605.
• Liddy, S., Worsley, D., Torreggiani, W., & Feeney, J. (2017). Preoperative imaging in primary hyperparathyroidism: literature review and recommendations. Canadian Association of Radiologists Journal, 68(1), 47-55.
• Bilezikian JP, Khan AA, Silverberg SJ, Fuleihan GE, Marcocci C, Minisola S, Perrier N, Sitges-Serra A, Thakker RV, Guyatt G, Mannstadt M, Potts JT, Clarke BL, Brandi ML; International Workshop on Primary Hyperparathyroidism. Evaluation and Management of Primary Hyperparathyroidism: Summary Statement and Guidelines from the Fifth International Workshop. J Bone Miner Res. 2022 Nov;37(11):2293- 2314. doi: 10.1002/jbmr.4677. Epub 2022 Oct 17. PMID: 36245251.
• Petranović Ovčariček, P., Giovanella, L., Carrió Gasset, I., Hindié, E., Huellner, M. W., Luster, M., ... & Verburg, F. A. (2021). The EANM practice guidelines for parathyroid imaging. European journal of nuclear medicine and molecular imaging, 48(9), 2801-2822.
• Patel, C. N., Salahudeen, H. M., Lansdown, M., & Scarsbrook, A. F. (2010). Clinical utility of ultrasound and 99mTc sestamibi SPECT/CT for preoperative localization of parathyroid adenoma in patients with primary hyperparathyroidism. Clinical radiology, 65(4), 278-287.
• Castro, A. A., Utrilla, V. S., Castro-García, J. M., García, D. M., Ruiz-Gómez, M. J., Portero, F. S., & Pinos, D. D. (2025). Imaging localization strategies in primary hyperparathyroidism. Radiología (English Edition), 501735.
• Bollerslev, J., Rejnmark, L., Marcocci, C., Shoback, D. M., Sitges-Serra, A., van Biesen, W., & Dekkers, O. M. (2022). Managing parathyroid disorders: Primary hyperparathyroidism (concise summary). European Society of Endocrinology. https:// www.ese-hormones.org/media/rtmdvlyi/ phpt_concise_summary_final_020322.pdf
• Wright, M. C., Jensen, K., Mohamed, H., Drake, C., Mohsin, K., Monlezun, D., ... & Kandil, E. (2017). Concomitant thyroid disease and primary hyperparathyroidism in patients undergoing parathyroidectomy or thyroidectomy. Gland surgery, 6(4), 368.
• Melcarne, R., Docimo, G., Aiello, P. S. L., Andreani, S., Avenia, N., Basili, G., ... & Boniardi, M. (2025). Intraoperative nerve monitoring in thyroid and parathyroid surgery: a decade of Italian practice. Updates in Surgery, 77(5), 1563-1579.